Therapy for Stress Urinary Incontinence (USI)
 

Contemporary Surgery for Stress Urinary Incontinence:
M. NEUMAN

The Tension-free Vaginal Tape (TVT) procedure is a well-established surgical procedure for the treatment of female stress urinary incontinence. The operation, described by Ulmsten in 1996, which is based on a mid-urethral Prolene tape support, is accepted worldwide as an easy-to-learn, effective and safe surgical technique. However, typical TVT operative complications of concern to the operating surgeons include: bladder penetration, urinary outlet obstruction, potential bowel penetration, intra-operative bleeding and post-operative infections.

 

Against this background, Delorme (2001) and de Leval (2003) were encouraged to design novel mid-urethral slings in the form of an "out-side-in" and then “inside-out" trans-Obturator TVT-like procedure. In such, the TVT needle bypasses the retro pubic area, which is in intimate proximity with the bladder, bowel and blood vessels, by making the needle route pass through the relatively safe medial compartment of the Obturator fossa area, remote from the pelvic viscera and vessels.

 

The TVT-Obturator was shown to be a safe and easily performed minimally invasive anti-incontinence procedure. The novel TVT-SECUR and other similar mini-tapes were designed to overcome two of the peri-operative complications reported with use of the TVT-Obturator: thigh pain and bladder outlet obstruction.

 

This was addressed by tailoring the tape to only 8 cm long and anchoring the tape edges into the internal Obturator muscle, rather than passing it through the Obturator foramen, muscles and membrane. The initial pull-out force of the tape and further tissue ingrowth were studied in the sheep model, revealing satisfactory figures. The early published data is encouraging in terms of cure rates as well as safety an simplicity.


 

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